Orthodontics and Surgery

Most of the time, individuals with misaligned teeth or other bite problems can be successfully treated with the many types of orthodontic appliances now available. Jaw development in a growing child can even be guided to improve tooth alignment when appropriate treatment is received before puberty. But sometimes, orthodontics alone isn't enough to correct problems with the teeth or jaws. That's when a surgical approach may be needed.

Corrective jaw surgery (also called orthognathic surgery) may be recommended for orthodontic problems that are skeletal in nature — meaning the misalignment of the bite is caused not by the position of the teeth in the jaws, but rather by the size or position of the jaws themselves. Some examples include: an open bite, where the upper and lower teeth don't meet when the mouth is closed; a protruding lower jaw, which makes the lower lip and chin appear too far forward; or a receding lower jaw, which makes the chin less prominent. Correcting these issues in an adult may involve surgically modifying one or both jaws. The goal of corrective jaw surgery is to improve basic oral functions such as chewing, swallowing, speaking and breathing, and to restore facial symmetry.

A Team Approach

Jaw surgery performed in combination with orthodontic treatment is a collaborative process that often includes orthodontists, general dentists, and oral and maxillofacial surgeons. The first step is a thorough evaluation by the orthodontist and the surgeon, which typically includes x-rays and other diagnostic imaging (such as photographs and CT scans), and actual or virtual models of the dentition (teeth and jaws). Using this information, a complete treatment plan will be designed for each individual's situation.

Several months of orthodontic treatment is often necessary before surgery, to align the upper and lower teeth in preparation for the procedure. The surgery itself is generally performed under general anesthesia in a hospital, an ambulatory surgical center, or an in-office operating suite. Following a recovery period, a second phase of orthodontic treatment may be needed to make minor adjustments and ensure the stability of the re-aligned bite. The total treatment period, including pre- and post-operative orthodontics and surgery, may be 1–3 years.

Evaluating a Surgical Solution

Orthognathic surgery is generally only considered when more conservative treatments (such as orthodontics) are judged insufficient. Thus, it isn't typically appropriate for a minor malocclusion (bad bite), but may be recommended for moderate to severe misalignment of the jaws. As with any type of surgery, it carries certain risks, including infection, numbness and adverse reactions to medications or anesthetics. Before any procedure is undertaken, the potential benefits and risks will be explained; you should feel free to ask for more complete information about any aspect of treatment you don't fully understand.

Because this type of surgery makes permanent changes to the jaws, it isn't suitable for young people whose bones are still growing; however, for adults and some teens, corrective jaw surgery can bring about many positive changes in oral function and appearance that couldn't otherwise be achieved.

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